Periodontal Specialists: Dr. Herbert Veisman

Periodontal Procedures

• Dental Implants

  What are dental implants? A natural tooth consists of a root and a crown. If you compare natural teeth to implant-supported replacement teeth, you’ll see they have the same basic parts. Both have a crown (the visible part used to chew food). Both have a root that holds the tooth securely under the gum and is anchored into the jaw. The difference is that the implant is made of titanium – the same time-tested material used by surgeons for artificial joints. When you lose a tooth, you lose both the root and the crown. To replace the tooth, the surgeon first replaces the root with a small dental implant. Time is allowed for bone to heal and grow around the dental implant. The bone bonds with the titanium, creating a strong foundation for artificial teeth. A support post (abutment) is then placed on the implant and a new replacement tooth (crown) is placed on top of the abutment. In many cases, a temporary replacement tooth can be attached to the implant immediately after it is placed. If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth. Surgical Advances in Dental Implants: Using the most recent advances in dental implant technology, Dr. Flores is able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of six weeks of healing time before artificial teeth are placed. There are even situations where the implant can be placed at the same time as the tooth extraction – further minimizing your number of surgical procedures. Dental implant placement is a team effort between a periodontist and a restorative dentist. Dr. Flores performs the actual implant surgery, initial tooth extractions, and bone grafting if necessary. The restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.

• Scaling & Root Planing

  The initial stage of treatment for periodontal disease is usually a thorough cleaning that may include scaling or root planing. The objective of these non-surgical procedures is to remove etiologic agents such as dental plaque and tartar, or calculus, which cause gingival inflammation and disease. Scaling and root planing can be used as a stand-alone treatment, or a preventative measure. They are commonly performed on cases of gingivitis and moderate-to-severe periodontal disease. We will only perform scaling and root planing after a thorough examination of the mouth, which may include taking x-rays and visually examining the mouth. Depending on the condition of the gums, the amount of tartar present, the depth of the pockets, and the progression of periodontitis, we may recommend scaling and root planing. In some cases, a local anesthesia may be used during the procedure. Scaling: When scaling is performed, calculus and plaque that attaches to the tooth surfaces is removed. The process especially targets the area below the gum line, along the root. Scaling is performed with a special dental tool called an ultrasonic scaling tool. The scaling tool usually includes an irrigation process that can be used to deliver an antimicrobial agent below the gums to help reduce oral bacteria. Root Planing: Root planing is performed in order to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed, which promotes healing, and also helps prevent bacteria from easily colonizing in the future.

• Gum Grafting

  When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost. In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth. When significant, gum recession can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging. A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root. The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.

• Crown Lengthening

  Why would I need crown lengthening? Crown lengthening is usually performed to improve the health of the gum tissue, prepare the mouth for a procedure, or correct a “gummy smile”. A “gummy smile” is used to describe an instance where teeth are covered with excess gum tissue resulting in a less esthetically-pleasing smile. The procedure involves reshaping or recontouring the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. Crown lengthening can be performed on a single tooth, many teeth, or the entire gum line. Crown lengthening is often required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not immediately accessible. It is also usually too close to the bone or below the bone. Crown lengthening allows us to reach the edge of the restoration, ensuring a proper fit to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease. About the Crown Lengthening Procedure: Crown lengthening takes approximately one hour but will largely depend on the amount of teeth involved and if any amount of bone will need to be removed. The procedure is usually performed under local anesthetic and involves a series of small incisions around the tissue to separate the gums from the teeth. Even if only one tooth requires the procedure, it will probably be necessary to adjust the surrounding teeth to enable a more even reshaping. In some cases, extraction of a small amount of bone will be necessary as well. When we are satisfied that the teeth have sufficient exposure and the procedure is completed, the incisions will be cleaned with sterile water. Sutures and a protective bandage are then placed to help secure the new gum-to-tooth relationship. Your teeth will look noticeably longer immediately after surgery because the gums have now been repositioned. You will need to be seen in one or two weeks to remove the sutures and evaluate your healing. The surgical site should be completely healed in approximately two to three months following the procedure.

• Periodontal Maintenance

  Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth.

• Professional Teeth Cleaning

  A dental prophylaxis is a cleaning treatment performed to thoroughly clean the teeth and gums. Prophylaxis is an important dental treatment for stopping the progression of gingivitis and periodontal disease. Professional teeth cleaning is an effective procedure in keeping the oral cavity in proper health and halting the progression of gum disease. The benefits include: Plaque removal. Tartar (also referred to as calculus) and plaque buildup, both above and below the gum line, can result in serious periodontal problems. Unfortunately, even with a proper home brushing and flossing routine, it can be impossible to remove all debris, bacteria and deposits from gum pockets. The experienced eye of a dentist or hygienist using specialized dental equipment is necessary to catch potentially damaging buildup. A healthier looking smile. Stained and yellowed teeth can dramatically decrease the esthetics of a smile. Prophylaxis is an effective treatment in ridding the teeth of these unsightly stains. Fresher breath. Bad breath (or halitosis) is generally indicative of advancing periodontal disease. A combination of rotting food particles (possibly below the gum line) and potential gangrene stemming from gum infection, results in bad breath. The routine removal of plaque, calculus and bacteria at our facility can noticeably improve halitosis and reduce infection.